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Directorate of Health Services, Kerala (Public Health Divn .) Influenza A H1N1 A B C G uidelines (adapted from the GoI - MoHFW guidelines, and updated 2017 July ) Case definition of ILI ( Influenza Like Illness ) An acute respiratory infection with : - • Measured fever of ≥ 38 C ° (≥100 o F) • And any of the respiratory symptoms including coryza , sore throat, cough with onset within the last 10 days. 1. Categorization • Category A - An ILI case not r

equiring hospitalization. • Category - B (Bi) An ILI case which might require hospitalization, due to comparatively severe onset • ( Bii ) Cat A ILI cases with any of the following physiological or co - morbid condition irrespective of hospitalisation -- • Pregnancy or post natal period • Pre - existing Diabetes / lung/ heart / liver/ kidney / neurological disease, blood disorders/ / cancer / HIV - AIDS etc • On long term steroids, or those with immuno - supr

ession due to drugs, radiation, etc . • Age ≥ 65 years. • Category - C • ILI cases with ANY ONE of the following conditions -- 1. breathlessness, 2. chest pain 3. drowsiness 4. fall in blood pressure, 5. haemoptysis 6. cyanosis • ILI cases in children with with ANY ONE of the red flag signs 1. somnolence, 2. high / persistent fever, 3. inability to feed, 4. convulsions, 5. dyspnoea /respiratory distress, etc. 2 . Influenza A H1N1 Testing: • O

nly Sentinel type testing -- for epidemiological purposes ( , ie , for a constant monitoring of the prevalence in a District / region, keeping watch on swab positivity rates etc ) • supervised by respective District Surveillance Officers (DSO) • Other than this, testing may sometimes be indicated in - – unusual clinical presentations, – for retrospective confirmation in such a death, – failure to respond even after 5 days extension of conventional Oseltamivir thera

py, – localised outbreak - like situation in an institution like a school, hostel, campus, etc • Testing SHOULD NOT be used for clinical management decision to initiate Oseltamivir treatment. Do NOT wait for test results on any occasion, to initiate Oseltamivir treatment. • If testing is felt indicated, contact your DSO for guidance . Influenza A H1N1 Testing … contd Specimens required - • 1 throat swab and 1 nasal swab, -- Dacron swab, -- immersed together in single V

TM (Viral Transport Medium) tube, immediately - cold chain/ refrigerated till dispatch at 2 - 8 degrees C . • Endo tracheal aspirate in VTM tube , if the patient is ventilated. • Specimen -- Triple layer packed -- despatched through the DSO -- reverse cold chain. Never send parcels directly/ through bystanders. • Testing centres – Two authorized testing centres for Kerala** --- • Manipal Centre for Virus Research (MCVR), KMC, Manipal University Manipal , Udupi

, Karnataka State. • NIV Unit, Medical College, Alappuzha • ** At any point in time either lab may not be active due to materials /supplies issues. Details from time to time will be available with DSO/DMO of your district 3. Management: • ILI - Category - A - -- No Oseltamivir required • -- Symptomatic treatment • -- Good supportive measures • Plenty of warm nourishing oral fluids, • Good food intake inc

luding locally available Vit A rich fruits and green leafy vegetables • Complete rest • -- Monitor progress , and reassess , at 24 to 48 hours • Any suggestion of deterioration / failure to improve? -- report in person immediately to treating doctor . • ILI Category - B • (B - i and B - ii) • (B - i ) ----------------- Home isolation / rest • --- Oseltamivir may very often need to be started as per clinical assessment and t

he availability of patient for direct follow up ; • (B - ii) ---------------- Start Oseltamivir immediately • If any suggestion of deterioration/ failure to improve, patient is to report in person immediately to treating doctor. • ILI Category - C – Start Oseltamivir immediately, WITHOUT WAITING FOR TEST RESULTS if testing already done. This has to be given as co prescription along with all other intensive measures and drugs being used. • Hospitalization immediately • Inte

nsive supportive management as necessary. 4. IMPORTANT NOTES: • Pregnancy and antenatal period, & immediate post natal period  extremely high risk periods • So , -- ILI related with pregnancy  suspect H1N1 , START OSELTAMIVIR IMMEDIATELY at standard dose. • If referring to a higher centre then IT IS MANDATORY TO START OSELTAMIVIR before referral and the drug should be continued at higher centre also. • Oseltamivir in pregnancy is considered safe • “Counseled

prescription” should be given . IMPORTANT NOTES contd … • NEGATIVE Real Time PCR for Influenza A H1N1 DOES NOT RULE OUT Influenza A H1N1 infection. • Irrespective of any Influenza A H1N1 Real Time PCR test result, Oseltamivir therapy full course should be completed once started . • Influenza A H1N1 is a seasonal virus and it is prevalent in the community. • Best infection control practices include regular and frequent hand - washing / hand hygiene also. 5.Oseltamivir

dosage schedule • Dose for treatment is as follows : – By Weight: • For weight 5kg 30 mg BD for 5 days • 15 - 23kg 45 mg BD for 5 days • 24 - 0kg 60 mg BD for 5 days • �40kg 75 mg BD for 5 days • • For infants: • 3 months 12 mg BD for 5 days • 3 - 5 months 20 mg BD for 5 days • 6 - 11 months 25 mg BD for 5 days • • It may also be available as syrup (12mg per ml ) -- &#

x0000;administered in powdered sugar, sugar syrup, or honey. • • SPECIAL DOSE --- If needed dose & duration can be modified as per clinical condition Eg , in Cat C cases only, where the response is assessed as 'not enough' by the treating team, dose may be increased to 150 mg BD one a one to one basis. • • *** Dose for chemoprophylaxis (only in special circumstances - see section 6 ) is similar, except that it is Once daily, for 10 days ( see section 6 ) 6. Chemo pro

phylaxis • Widespread Chemoprophylaxis to family/school/social contacts of a positive case NOT NEEDED - But -- – For those contacts of a documented case of H1N1 with high risk Eg . pregnancy/ diabetes / liver / kidney disease, Asthma / immuno - suppressed / very low or high age etc etc as in Cat B - ii, Oseltamivir 1 OD x 10 days may be given – Other contacts – reassure, recommend watchfulness, assess category. If and when they show any symptoms, , then treat as per ABC

guidelines 7. General Guidelines for schools / educational institutions if outbreak escalates • Medical certificate should not be insisted on from preventive absentees . • Promote frequent hand wash with soap and water. • All to observe strict cough / sneeze etiquette, teachers to continuously educate and mentor students in this regard • Regular cleaning with the regular cleaning agent they ordinarily use • Hostels need not be closed down, but monitor the health of res

ident students and staff regularly HELP! • For any clarifications or any related advice, please contact your DMO / DSO (Dist. Surveillance Officer ), or call DISHA Helpline on 0471 - 2552056, or 1056 toll free • Please visit www.dhs.kerala.gov.in or www. arogyakeralam.gov.in Thank you! Dr Amar Fettle State Nodal Officer - H1N1 & other PHEICS PH Divn ., NHM, Directorate of Health Services, Thiruvananthapuram 16 Tel 94474 51846 / 99461 23995 h1n1kerala@gmail